Provider Demographics
NPI:1528275278
Name:MAHADEEP VIRK DMD-EDMONDS PS
Entity type:Organization
Organization Name:MAHADEEP VIRK DMD-EDMONDS PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHADEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-778-6333
Mailing Address - Street 1:23805 HIGHWAY 99
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9204
Mailing Address - Country:US
Mailing Address - Phone:425-778-6333
Mailing Address - Fax:425-778-6115
Practice Address - Street 1:23805 HIGHWAY 99
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9204
Practice Address - Country:US
Practice Address - Phone:425-778-6333
Practice Address - Fax:425-778-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty